RN Senior Clinical Consultant

Become a part of our caring community and help us put health first
The Senior Stars Improvement, Clinical Professional (RN) is responsible for the development, implementation and management oversight of the company's Medicare Stars Program in the Florida region.

*Central and North Florida areas, exclude South Florida area and Panhandle. Far north Florida limit would be Jacksonville

The Senior Stars Improvement Clinical Professional (RN)

• Develops programs designed to increase the plan quality.
• Medical records reviews will be 40% of role and 60% of role is participating in strategies that will support Humana provider specific measure care gap closure.
• Partners with leaders regarding implementation planning. Reviews and communicates results of programs.
• Provider non-standard supplemental data trending
• Provider level HEDIS in service
• Develop and implement measure specific strategies
• Provider and Member outreach on focused care gap measures
• EMR remote strategy for Humana provider care gap closure on targeted measures
• Provider office in person, Zoom virtual or telephonic meetings
• Weekly metrics for provider outreach may apply, some Zoom telephonic outreach will entail cold calling to the in-network providers to establish working relationships
• Quality/clinical management and population health
• HEDIS and Stars performance
• Operational improvements
• Financial performance and incentive programs
• Data sharing and connectivity, interoperability opportunities
• Documentation and coding
• Additional areas related to provider performance, member experience, market growth, provider experience and operational excellence

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

• Medical Benefits
• Dental Benefits
• Vision Benefits
• And more

Use your skills to make an impact

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in Florida
• 5 or more years of clinical nursing experience
• 1 or more years of Medical Records auditing experience, in the past 5 years
• 1 or more years of provider office and/ or clinic management experience, in the past 5 years
• Comprehensive knowledge of Microsoft Office applications, Word and Excel with advanced knowledge of PowerPoint
• Excellent presentation and communication skills, both oral and written
• Strong relationship building skills as this is a provider-facing role
• Strong attention to detail with a focus on process and quality
• Valid driver's license with reliable transportation and the ability to travel up to 40% within the region

Preferred Qualifications

• Bachelor's degree in Nursing
• 3 or more years years of managed care experience
• 3or more years years of case management experience
• Working knowledge of HEDIS/Stars/CMS

Additional Information

• Hours for the role are: Monday-Friday 8am-5pm EST
• This role is remote/virtual, but candidate may travel to provider offices within region up to 40% and travel to market offices within region for in person meetings

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

#LI-BB1

Scheduled Weekly Hours

40

Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.